Résumé
PURPOSE: Complete release of the transverse carpal ligament(TCL) is accepted as the standard treatment for carpal tunnel syndrome(CTS). However, loss of grip and pinch power are reported in some patients after complete release of the TCL. This study was designed to evaluate the effectiveness of complete versus partial carpal tunnel release by using the inching technique. METHODS: Nineteen patients(a total of 27 hands) who each had a confirmed diagnosis of CTS were selected from September 2002 to February 2003. The cases were divided into three groups(mild, moderate and severe) based on preoperative electrodiagnostic studies. The patients with partial carpal tunnel syndrome were classified into the mild or moderate groups, while patients with complete carpal tunnel syndrome were classified into the moderate or severe groups. Patient oriented data (functional and symptomatic) were collected and electrophysiologic studies were undertaken preoperatively and postoperatively(on the 2nd week, 1st month, 3rd month and 6th month after surgery). RESULTS: In this study, the mild and moderate groups showed both good functional and symptomatic results and improvements in electrophysiologic studies. CONCLUSION: Carpal tunnel syndrome patients classified into mild or moderate groups based on nerve conduction studies, and whose precise compression sites were pinpointed using the inching technique, can be treated by partial carpal tunnel release.
Sujets)
Humains , Syndrome du canal carpien , Diagnostic , Études de suivi , Force de la main , Ligaments , Conduction nerveuseRésumé
PURPOSE: For hypertrophic scars and keloids no universally effective treatment modality exists. Surgical revision, intralesional steroid injection, silicone gel sheeting, pressure, laser, and others have been used with variable success, but many treatments are associated with high recurrence rates. Although optimal treatment remains undefined, successful treatment can be obtained through a combined therapeutic approach. METHODS: We used three therapeutic modalities in combination, which are intralesional injection of triamcinolone acetonide, silicone gel sheeting, and 585 nm flashlamp-pumped pulsed dye laser. Fifty-eight cases of hypertrophic or keloid scar were treated by combined therapeutic regimen for mean period of 18 months. The changes of thickness, color, and pliability of scars were evaluated with clinical photographs by grading scale. RESULTS: As summing the grades and categorizing the result into three group, we obtained 28% good, 67% fair, and 5% poor results. There was a desirable improvement of scars with insignificant adverse effects. CONCLUSION: Combination of intralesional steroid injection, silicone gel sheeting, and pulsed dye laser can lead to successful treatment of hypertrophic scar and keloid.
Sujets)
Cicatrice , Cicatrice hypertrophique , Association thérapeutique , Injections intralésionnelles , Chéloïde , Lasers à colorant , Flexibilité , Récidive , Réintervention , Gels de silicone , Triamcinolone acétonideRésumé
PURPOSE: For hypertrophic scars and keloids no universally effective treatment modality exists. Surgical revision, intralesional steroid injection, silicone gel sheeting, pressure, laser, and others have been used with variable success, but many treatments are associated with high recurrence rates. Although optimal treatment remains undefined, successful treatment can be obtained through a combined therapeutic approach. METHODS: We used three therapeutic modalities in combination, which are intralesional injection of triamcinolone acetonide, silicone gel sheeting, and 585 nm flashlamp-pumped pulsed dye laser. Fifty-eight cases of hypertrophic or keloid scar were treated by combined therapeutic regimen for mean period of 18 months. The changes of thickness, color, and pliability of scars were evaluated with clinical photographs by grading scale. RESULTS: As summing the grades and categorizing the result into three group, we obtained 28% good, 67% fair, and 5% poor results. There was a desirable improvement of scars with insignificant adverse effects. CONCLUSION: Combination of intralesional steroid injection, silicone gel sheeting, and pulsed dye laser can lead to successful treatment of hypertrophic scar and keloid.